Methotrexate and cyclosporine are effective in the treatment of patients with moderate-to-severe psoriasis, which not only enables patients with moderate-to-severe psoriasis to improve their treatment efficiency but also promotes their recovery.
When the 2 drugs are used in combination, the dosage of both can be reduced, thus lowering the cumulative dose and possibly reducing the hepatotoxicity of methotrexate and the nephrotoxicity of cyclosporine. It may be carefully considered for patients with refractory psoriasis who have failed to respond to conventional drug monotherapy, are allergic to biologic ingredients, or cannot afford the cost of biologics.
Next, we will look at the indications, use, and improvement of the effects of the two drugs, methotrexate and cyclosporine, respectively, as well as the possible adverse effects during their use.
Methotrexate tablets
I. Methotrexate
Effects and improvement effect
Methotrexate is a kind of folate reductase inhibitor, which is the standard drug for the treatment of psoriasis in China at present. It is more effective in the treatment of psoriasis, can better reduce the symptoms of itching and flaking of patients and shrink the area of skin lesions, and has a low rate of adverse reactions.
Indications
– Methotrexate is indicated for moderate-to-severe plaque psoriasis (lesion area >10% body surface area).
– Erythrodermic psoriasis as well as severe pustular psoriasis.
– Arthritic psoriasis; patients with refractory psoriasis who have failed to respond to systematic use of retinoids and ultraviolet phototherapy [complementary long-wave ultraviolet (PUVA) and narrow-spectrum medium-wave ultraviolet (UVB)].
– Patients with psoriasis whose lesions occur on the head, face, extremities and/or perineum, etc. and have a significant impact on the patient’s appearance and function, resulting in a severely impaired quality of life.
Adverse reactions
Patients may experience different degrees of adverse reactions after using the drug, including skin pigmentation, gastrointestinal discomfort, fatigue, headache, dry mouth, etc., while most patients can tolerate it after prolonged treatment; some patients may experience serious adverse reactions such as liver and kidney function damage and bone marrow suppression.
Precautions
During the medication period, it is necessary to strictly follow the doctor’s prescription, pay close attention to the acute adverse reactions and observe whether they are well tolerated, as well as to regularly monitor the blood routine and liver and kidney functions in the hospital in order to detect abnormalities such as liver and kidney function damage and bone marrow suppression in time for timely intervention.
II. Cyclosporine
Action and improvement effect
Cyclosporine is an immunosuppressant, which can be used for the treatment of psoriasis, especially for moderate to severe plaque psoriasis. There are various ways to use cyclosporine in the treatment of psoriasis, such as intermittent short-term therapy with a single drug, continuous long course therapy, rescue therapy and combined therapy with traditional drugs or biological agents, depending on the specific situation of the patient, all of which have shown better efficacy.
Indications
– Cyclosporine has been associated with adverse effects such as hypertension and nephrotoxicity. Cyclosporine is a potent immunosuppressant and can play an important role in the treatment of immune-mediated moderate to severe psoriasis.
– In addition, cyclosporine in short-term combination with methotrexate is an effective and safe treatment for heavy psoriasis and can be used as one of the treatments for heavy psoriasis.
Adverse reactions and precautions
As cyclosporine has many contraindications and adverse reactions, long-term use may lead to elevated blood pressure and abnormal renal function. When using cyclosporine, attention should be paid to the therapeutic dose and duration, monitoring of adverse reactions and related items, and monitoring of blood concentration if necessary. Usually the treatment is intermittent remission combined with other drugs in the early course of treatment, so that other drugs can take effect quickly and thus enhance the efficacy.
References
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[4]Wei X. T. Clinical effects of methotrexate in the treatment of moderate-to-severe psoriasis [J]. World abstract of the latest medical information (continuous electronic journal),2015(32):96.
[5]Expert consensus on the application of methotrexate in the treatment of psoriasis [J]. Journal of Clinical Dermatology,2022,51(02):108-117.